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We correlated the prenatal severity with the postnatal outcome of prenatally detected renal pelvic dilatation (RPD).Cases of prenatally detected RPD referred between January 2002 and December 2008 were included. Severe RPD was defined as an anterior–posterior diameter of 15 mm, mild and moderate dilatation was defined as 6 to <10 mm and 10 to <15 mm, respectively. Postnatal diagnosis, the need for surgery and the correlation with the prenatal severity was ascertained.Of the 762 patients with RPD, 492 (64.5%) were mild, 167 (21.9%) were moderate, and 103 (13.5%) were severe. The male:female ratio for the severe cohort was 5:1. Of the sever cases, 68% had progressive dilatation. Of the mild/moderate cases, 5% progressed to severe dilatation. PUJ obstruction was confirmed in 48 cases (60.8%), severe VUR in 11 cases (14%), VUJ obstruction in 5 cases (6%), PUV in 2 cases (2.5%), and a nonidentifiable cause in 13 cases (16.5%). Ten of the 48 (20.8%) babies with PUJ obstruction required surgery within the first year of life.An obstructive cause is usually present in severe cases, which are more likely to require surgery if there is PUJ obstruction. A high male:female ratio was present in this group. © 2012 John Wiley & Sons, Ltd.